Donald Trump. Businessman, television personality, father, reality TV star (popularizer of the phrase "You're fired"), author, Republican party nominee for the United States presidential election, and now... psychiatrist? Last week at an event in Youngstown, Ohio, Trump claimed that Democratic Presidential nominee Hillary Clinton “lacks the mental and physical stamina to take on ISIS.” Did Trump do a psych evaluation of Clinton? (If so, not sure why Clinton would choose Trump as a psychiatrist or psychologist when she has other choices.) And if so, is there no end to this man's talents?
When someone tries to smear your reputation, they may resort to claims about your mental health or stamina. Why? Because mental health issues are not like a mole or explosive diarrhea. They are not as easy to either diagnose or refute. Explosive diarrhea is a lot clearer (or more solid, depending on the type of diarrhea you have). "Show me the massive diarrhea" is all you have to say, using your best Tom Cruise impression from the movie Jerry McGuire. But when someone says something about your mental health, how can that be verified?
Certainly, there are obvious cases of mental distress. Someone who keeps repeating the word "matchsticks" constantly every minute, every day, may have something going on, assuming there aren't matchsticks raining down. But often people throw around mental health diagnoses without even thinking about what they mean. Oh, that person's crazy. Depressed. Manic. A narcissist. Schizo. Mentally unfit. Blah, blah, blah. Lots of "mental health diagnoses" offered when people want to insult or assess someone else. It is amazing how many board-certified psychiatrists and psychologists are seemingly present, even among junior high and high school students. And here I thought you needed to go to medical or graduate school to be a mental health professional. What's the accuracy of such diagnoses? Well, considering that they are often used by people who either have no formal training in mental health or have an agenda or both...very, very low.
Here Clinton responds on the Jimmy Kimmel Show to mental stamina claims and opens a jar of pickles (pickles? what does this have to do with anything...you'll see):
Mental health is one of the most misunderstood areas of medicine and public health. While there is a shortage of mental health professionals in many locations, there seems to be an overabundance of people who think or act like they understand mental health. This Washington Post piece quotes Thomas Insel, director of the National Institute of Mental Health as saying that more than half of U.S. counties have no mental health professionals and so "don't have any access whatsoever." As the Wall Street Journal reported, in U.S. between 2005 and 2010, the general population grew 4.7%, but the number of psychiatrists dropped from 38,578 to 38,289. Trump is probably not one of them (unless Trump University offered a fully-accredited medical degree and psychiatry residency programs.)
Remember you can't diagnose mental health or mental stamina from afar -- even if you are a psychiatrist or psychologist. You can't even diagnose from a-near, if you do not really understand what you are doing or did not conduct a formal exam. A real mental health diagnosis or assessment requires an in-person formal evaluation by a trained professional following the guidelines for mental health diagnoses. The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a manual published by the American Psychiatric Association (APA). After the first edition came out, there has been multiple subsequent editions with revisions and additions. each time a new edition is published, it is called DSM followed by the edition number. Thus, the second edition was DSM-2. The third edition DMS-3 and so forth until the DSM-5, published in 2013. The DSM includes the formal diagnostic criteria for a wide range of established mental health issues and conditions. It's quite an extensive read in case you want to put down your Harry Potter or Fifty Shades of Gray for a moment. You will see that qualifying for a mental health diagnosis entails meeting a number of specific symptoms and signs.
A key component of diagnosing a mental condition is how long have the symptoms lasted. This is because everyone struggles here and there. Everyone feels down at times. Everyone experiences mental exhaustion occasionally. As REM sang, everybody hurts. There's a big difference between feeling down for a short bit versus a long, long time.
The second component is whether there is an external cause of the symptoms. If someone kicked your puppy, you would be angry or unhappy. If someone gives you a puppy and you like puppies, but you remain very unhappy for no particular reason then something may be amiss. (Unless the puppy had explosive diarrhea.)
Keep all of this in mind when you hear one candidate, one work colleague or one Mean Girl trying to denigrate another for personal gain. What are the facts supporting the claim? Sure, one candidate may appear tired on certain days. Does this mean a lack of stamina? Not necessarily. Campaigning is tiring, and people get tired -- unless they are taking some substance to keep them peppy. Does Clinton have the mental stamina to be President? Does Trump? Who knows?
Trump himself has been the target of mental health speculation. Is Trump a narcissist, as some claim? I don't know. A diagnosis of narcissism requires meeting particular criteria. With public figures such as Trump, how much of what you see is the real person or just part of a choreographed act? Even if Trump were to show narcissistic tendencies in public, if he doesn't in the privacy of his own home and with his family and friends, then he's probably not a true narcissist. Just a very good actor.
Here Jimmy Kimmel asks Dr. Phil if he thinks Trump is a narcissist:
Alas, with so many people throwing around mental health diagnoses without justification, the people who really need help may be overlooked. When evaluating people, why not stick to the facts, the things that can be measured? What has that person accomplished? What specific ideas, policies, plans, abilities and knowledge does a candidate bring to the table? Otherwise, you are left with inaccurate speculation and Mean Girls-like rumor mongering. Who cares if Clinton appeared tired for a moment? Does Trump's public persona make him a narcissist? Maybe Trump is a warm and gentle guy in his private life. Maybe.
